Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)

Scientific Rating:
NR
Not able to be Rated
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) has been reviewed by the CEBC in the area of: Trauma Treatment - Client-Level Interventions (Child & Adolescent), but lacks the necessary research evidence to be given a Scientific Rating.

Target Population: Traumatized adolescents with a history of exposure to chronic interpersonal trauma (such as ongoing physical abuse) and/or separate types of trauma (e.g. community violence, sexual assault), many of whom are still living with ongoing stress and unstable environments and/or complexly traumatized adolescents with or without current/lifetime PTSD

For children/adolescents ages: 12 – 18

Brief Description

SPARCS is a present-focused, 16-session manually guided group treatment. It is specifically designed to improve the emotional, social, academic, and behavioral functioning of adolescents exposed to chronic interpersonal trauma (such as ongoing physical abuse) and/or separate types of trauma (e.g., community violence, sexual assault). The curriculum was designed to address the needs of adolescents who may still be living with ongoing stress and may be experiencing problems in several areas of functioning. This can includes difficulties with affect regulation and impulsivity, self-perception, relationships, somatization, dissociation, numbing and avoidance, and struggles with their own purpose and meaning in life, as well as worldviews that make it difficult for them to see a future for themselves.

SPARCS is based primarily on cognitive-behavioral principles and teaches skills to foster resilience and enhance group members' current strengths. Experiential activities and discussion topics have been specifically developed for use with adolescents, and are designed to capitalize on developmental considerations that are particularly relevant for teenagers (e.g., issues related to autonomy and identity). It should be noted that SPARCS is a present-focused intervention, and is not an exposure-based model. Although there is no direct exposure component (e.g., no construction of a trauma narrative), traumas are discussed in the context of how they relate to the adolescents’ current behaviors and to their understanding of their problems and difficulties in the here and now.

The curriculum, which draws from the core components of complex trauma treatment, incorporates techniques from Dialectical Behavioral Therapy (DBT), Trauma and Grief Components Therapy (TGCT), and early versions of Trauma Adaptive Recovery Group Education and Therapy (TARGET). These techniques are utilized with participants throughout many of the group sessions.

Program Goals:

The overall goals of Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) are:

  • “The Four C’s”:
    • Coping more effectively in the moment
    • Connecting with others and establishing supportive relationships
    • Cultivating awareness
    • Creating meaning in their lives

Essential Components

The essential components of Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) include:

  • Mindfulness practice
    • Mindfulness exercises in each session include:
      • Group members participate in mindfulness exercises in each session. The exercises facilitate the practice of awareness, observing, describing, and fully participating in the moment without being judgmental.
      • Through the use of Mindfulness techniques, members increase their awareness of internal states (thoughts, feelings, physical sensations, and urges) and external experiences (what’s going on around them and in their relationships). Members learn how the environment impacts upon them emotionally, cognitively, and physiologically and become aware of their own internal and external “triggers.” Through increased awareness, adolescents are better able to notice how their emotions, thoughts, and behaviors affect what happens around them, and learn how to make choices mindfully even during stressful or dangerous situation.
      • Mindfulness skills emphasize staying in the present, observing without acting, and describing internal experience and external events without judgment.
      • Mindfulness exercises can also address somatic complaints by facilitating the recognition of the link between emotions and physiology.
      • Mindfulness exercises require that one focus and re-focus one's attention to the present. Adolescents are provided opportunities to practice this in a number of engaging ways.
  • Relationship building/communication skills
    • Group leaders teach MAKE A LINK skills, which provide concrete steps to foster healthier relationships and communicate more effectively. Adapted from the Interpersonal Effectiveness Skills in Dialectical Behavior Therapy for Adolescents, the MAKE A LINK steps are taught didactically and reinforced through role-plays designed to help participants learn to communicate their needs, address conflicts, and say “no” when warranted.
  • Distress tolerance
    • Distress tolerance skills, adapted from Dialectical Behavior Therapy, are taught in order to help adolescents tolerate stressful experiences that they cannot immediately change, without reacting in ways that make the situation worse.
  • Problem-solving and meaning making
    • Group leaders teach the LET 'M GO problem-solving steps, which include a sequence of skills for actively coping with current distress that is triggered by traumatic experiences. The LET 'M Go steps include a focus on helping group members identify the underlying values and beliefs (e.g., justice, trust, loyalty) that drive their behavior and the decisions they make. The “M” in LET ‘M GO emphasizes the ways in which these values and beliefs can be used to shape long-term goals and develop Meaning in their lives.
  • Psychoeducation regarding stress, trauma, triggers, and ways of coping
    • Group discussions include psychoeducation regarding common reactions to stress and trauma, triggers, and the types of coping strategies youth use in response to these experiences. Adolescents identify their MUPS (coping strategies that “Mess you UP”), and discuss the ways in which these strategies, while perhaps effective in the moment, often exacerbate original problems or create new ones.
  • Treatment Guide
    • Group leaders receive a 16-session treatment guide that concretely outlines specific content and skills to be covered in each session.
  • Member Workbook
    • Group members receive a color “workbook” that includes activities to work on during sessions.

Child/Adolescent Services

Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) directly provides services to children/adolescents and addresses the following:

  • Complex Trauma, including: Impairments in functioning and co-morbidities that stem from repeated and multiple victimizations and are not captured by a diagnosis of posttraumatic stress disorder (PTSD) alone. The areas of functioning addressed include problems with 1) regulating emotions and impulsive behavior, 2) successfully negotiating and developing trusting relationships, 3) seeing a purpose and future in life, 4) dissociation, 5) chronic physical complaints, and 6) negative self-perception. The program is also suitable for use with traumatized adolescents who may not meet criteria for PTSD but are experiencing behavior problems, school refusal, substance use, early pregnancy, and other high-risk behaviors.
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: The model can be implemented with parental involvement as part of multifamily group therapy.

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Day Treatment Program
  • Outpatient Clinic
  • Residential Care Facility
  • Residential Treatment Center
  • School
  • Juvenile detention/justice facility

Homework

Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) includes a homework component:

Group members are routinely encouraged to practice skills outside of group, and are provided with concrete practice assignments and handouts to complete between sessions. Some examples of the skills practiced include the self-soothe and distract skills from Dialectical Behavior Therapy, interpersonal skills, mindfulness exercises, trigger identification, and a problem-solving approach designed to help group members identify values and beliefs that are important to them.

Languages

Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Mental health clinician and co-therapist
  • Manual for each group leader
  • Color youth handouts specific to each session (1 workbook per client)
  • Group room
  • DVD Player and/or access to videos online
  • Snacks (optional)
  • Flipchart and markers
  • Assorted arts and crafts supplies
  • Miscellaneous materials for assorted activities (e.g. seltzer bottles, music, distress tolerance materials)
  • Complete session supply list available upon request

Minimum Provider Qualifications

Group leaders are generally mental health clinicians with a Master’s degree.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contacts:
Training is obtained:

Trainings can be conducted on-site for agencies who are interested in hosting their own Collaborative. Participants can also join an existing Collaborative that may be taking place in another part of the country. The number of trainers varies depending on the size of the training group. The trainer-participant ratio is generally small in order to allow for adequate interaction and in-vivo consultation during role-plays. Implementing the curriculum without formal training and consultation is discouraged as there are many concepts taught at the training that are not included in the manual and certain skills that appear self-explanatory (e.g., the LET ‘M GO problem-solving steps), require in-depth practice and coaching. Additionally, participation from clinical staff (2 group co-leaders), and typically a supervisor and/or administrator (both, if possible) is required for training. This level of commitment is essential in creating systemic change and ensuring the sustainability and availability of this program to youth long after the training has ended.

Number of days/hours:

SPARCS trainings are conducted using a “Learning Collaborative/Community” model of training, which consists of a planning/readiness phase, 4 days of training (conducted across two 2-day training sessions), consultation calls, and ongoing email/phone support throughout the duration of the collaborative (approximately 8-12 months). Training components include:

  • Pre-work/Planning Phase: Manuals sent to all participants. Clinicians, supervisors, & administrators complete the SPARCS Planning Worksheet as a team & participate in planning calls with trainers.
  • Learning Session 1: This is a two-day face-to-face training which includes a balance of didactic presentations, demonstrations, role-plays, and mindfulness practice.
  • Bi-weekly multi-site consultation calls occurring over 8 months: These calls have an emphasis on clinical application of material, fidelity, flexibility, sustainability, and evaluation.
  • Learning Session 2: This is a two-day face-to-face training approximately 6-8 weeks after the start of group.

Relevant Published, Peer-Reviewed Research

This program has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for a scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated." It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR - Not able to be Rated" classification, please see the Scientific Rating Scale.

Child Welfare Outcomes: Not Specified

Show relevant research...

Weiner, D. A., Schneider, A., & Lyons, J. S. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes. Children and Youth Services Review, 31, 1199-1205.

Type of Study: One group pretest-posttest design
Number of Participants: 33

Population:

  • Age — 13-18 years
  • Race/Ethnicity — 67% African American, 21% Caucasian, and 12% Hispanic
  • Gender — 64% Female and 36% Male
  • Status — Participants were children and adolescents with a moderate or severe traumatic experience.

Location/Institution: Six System of Care agencies

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) in a sample of ethnically diverse youth in foster care. Participants were assigned to one of three interventions: SPARCS for youth 13 to 18 years, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth 6 to 12 years, and Child-Parent Psychotherapy (CPP) for youth 0 to 6 years. The primary assessment tool used was the Child and Adolescent Needs and Strengths (CANS), administered 30 days after intake, 6 months into the intervention, and at post-intervention. Results indicated that all three interventions were equally effective at improving a range of trauma symptoms across racial groups. Limitations include the small sample size and lack of a control or comparison group.

Length of postintervention follow-up: None.

Habib, M., Labruna, V., & Newman, J. (2013). Complex histories and complex presentations: Implementation of a manually-guided group treatment for traumatized adolescents. Journal of Family Violence, 28, 717-728.

Type of Study: One group pretest-posttest study
Number of Participants: 24

Population:

  • Age — 14-21 years
  • Race/Ethnicity — 43% Caucasian, 34% African-American, 17% Latino, and 5% other
  • Gender — 75% Female and 25% Male
  • Status — Participants were complexly traumatized adolescents (mean number of different traumas = 7.1) in 3 residential treatment facilities.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article describes the outcomes of a pilot test of Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) in residential treatment facilities. Measures utilized were the Adolescent Trauma History Checklist & Interview (THCI), the Youth Outcome Questionnaire-Self Report (YOQ-SR), and the UCLA PTSD Reaction Index (RI). Results indicated that adolescents reported improvement on a wide range of emotions and behaviors, including anxiety and depressive symptoms, physical complaints, social relationships, attention and impulsivity, and high risk behaviors. Additionally, posttraumatic stress disorder (PTSD) symptoms also improved significantly over the course of treatment. Limitations include the small sample size, the lack of a comparison group, and a comparatively small number of male adolescents who participated in the treatment.

Length of postintervention follow-up: None.

References

DeRosa, R., & Pelcovitz, D. (2005). Treating traumatized adolescent mothers: A structured approach. In N. Boyd-Webb (Ed.), Working with traumatized youth in child welfare. NY: Guilford Press, pp. 219-245.

Ford, J., Blaustein, M., Habib, M., & Kagan, R. (2013). Developmental trauma therapy models. In J. D. Ford & C. A. Courtois (Eds), Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models (pp. 261-276). New York, NY: Guilford Press.

Habib, M., Labruna, V., & Newman, J. (2013). Complex histories and complex presentations: Implementation of a manually-guided group treatment for traumatized adolescents. Journal of Family Violence, 28, 717-728.

Contact Information

Name: Mandy Habib, PsyD
Agency/Affiliation: Adelphi University
Department: Dept. of Psychiatry
Email:
Phone: (917) 710-7335
Name: Victor Labruna
Agency/Affiliation: Adelphi University
Department: Dept. of Psychiatry
Email:
Phone: (516) 672-3859

Date Research Evidence Last Reviewed by CEBC: December 2015

Date Program Content Last Reviewed by Program Staff: October 2014

Date Program Originally Loaded onto CEBC: May 2006